This practice is rated as Outstanding overall. (Previous inspection February 2016 the practice was rated Outstanding)
The key questions are rated as:
Are services safe? – Outstanding
Are services effective? – Outstanding
Are services caring? – Good
Are services responsive? – Outstanding
Are services well-led? - Outstanding
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Outstanding
People with long-term conditions – Outstanding
Families, children and young people – Outstanding
Working age people (including those retired and students – Outstanding
People whose circumstances may make them vulnerable – Outstanding
People experiencing poor mental health (including people with dementia) - Outstanding
We carried out an announced comprehensive inspection at Marple Cottage Surgery on 22 February 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
At this inspection we found:
- The established strong leadership at the practice had a clear vision, which put working with patients to ensure high quality care and treatment as its top priority. There was a commitment by all the practice staff to deliver a quality service.
- The practice implemented a comprehensive strategy with supporting business plans that reflected their vision and values. A cycle of continuous quality improvement that incorporated all aspects of practice activity was implemented and aligned with the practice Strategy and Improvement Plan. This helped it to understand risks and gave a clear, accurate, and up to date picture that led to safety improvements.
- There was an individual and team ethos of commitment to deliver the highest quality services to patients. The whole practice team fostered a culture of ‘can do’ with patient care and customer satisfaction central to everything it did.
- The culture of the practice was to deliver a person-centred care and treatment service to all its patients. Its objectives emphasised the partnership approach between the practice and patients. This relationship was based on mutual respect and active involvement of patients in their own care by increasing education, promoting self-care and providing support with encouragement to lead healthier lives.
- The practice had been committed for many years to providing patients with full online access to their medical records. Feedback from patients identified this had helped them understand their health condition better.
- Following participation in the trialling of integrated video consultations, the practice now offered a video consultation service to patients. These appointments had been successfully used by patients whilst at work and for undertaking some long term condition reviews.
- The practice had clearly defined and embedded systems to minimise risks to patient safety. The practice had an inclusive approach to this and each member of the staff team had responsibility for implementing systematic checks to ensure patients received safe and timely care. A ‘Red Flag’ policy was accessible to all staff from their desktop computer whereby specific health care symptoms were triggers for staff to take immediate action.
- The GPs provided care and treatment to a range of community and residential services. These include providing end of life care to a community based ward, daily support to a specialised community ward for patients with delirium and weekly visits to a residential care home and a nursing home for patients with dementia.
- The practice implemented an annual training strategy. The practice had agreed with the staff team core goals and principles for 2018 and this provided a structure for regular planned training, staff meetings, and individual support.
- The training and development of trainee GPs and medical students was also structured. For example, trainee GPs were responsible (with support and supervision) for visiting all housebound patients biannually, to monitor healthcare needs and to undertake long term condition reviews.
We saw several areas of outstanding practice:
- The practice had a communication strategy, which was underpinned by its culture of providing patient-centred customer care. The practice trained its staff in customer care, used a communication protocol to respond positively and supportively to all customer/patient requests, and used feedback from patients/customers to improve on how the staff team communicated with people.
- The practice had recognised the anxiety and distress caused to families, designated next of kin and carers of patients accommodated in residential and nursing dementia care homes. To support these family members and carers the practice offered half hour appointments to discuss their relative’s health and treatment plan. These meeting also provided the opportunity for participants to agree the patient’s care plan including what actions should be taken in the event of deterioration in the patient’s health.
- The practice continued to be proactive in identifying Good Service Examples where staff had responded to the individual needs of a patient to ensure they received the right care and support. These Good Service Examples were logged and used as a learning and development aid for the staff.
- The practice peer reviewed all secondary care referrals. All GPs including locum GPs had to request a peer review of every secondary care referral they proposed to make. Systems were effectively established so that all referral were logged and reviewed by another GP within a two to three hour timescale.
- The practice facilitated and supported its patients and the local population to provide health education meetings. The Chief Clinical Officer from Stockport Clinical Commission Group provided the most recent patient education event “Stockport Together”. The practice invited patients from other GP surgeries in the Marple area. Seventy people attended. The practice had arranged a follow up meeting in March 2018 to allow the Stockport Together team to answer questions on how the initiative would affect Marple.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice